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Finance Committee to seek provider input on fraud prevention

Panel is already looking into complaints about RAC, ZPIC programs, investigative counsel says


By Joe Carlson
Posted: May 1, 2012 - 7:00 pm ET
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Senate Finance Committee members plan to issue an open letter to U.S. healthcare providers Wednesday to broadly solicit advice on the best ways to prevent waste, fraud and abuse in federal healthcare programs.

Kimberly Brandt, chief healthcare investigative counsel for committee's Republican staff, told an audience at a conference Tuesday that senators have also been conducting an informal inquiry into the actions of controversial healthcare auditing contractors, including Zone Program Integrity Contractors and Recovery Audit Contractors.

Speaking at the Health Care Compliance Association's annual Compliance Institute in Las Vegas, Brandt said the inquiry into ZPICs, RACs and other auditing contractors stems from numerous complaints senators have received from providers. The committee has been documenting contractors' tactics and instances where the private companies give confusing or contradictory guidance, she said.

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The senators hope to receive feedback on the audit contractors in response to the open letter going out to providers, she said. The letter itself stems from a recent Senate Finance Committee hearing that left questions in the minds of many observers about the effectiveness of the ongoing efforts to fight waste and fraud in federal healthcare programs like Medicare.

Lester Perling, a partner in healthcare law at Broad and Cassel, said during the panel discussion in Las Vegas that ZPICs in particular have been criticized for trying to assert sweeping investigative powers that even the FBI wouldn't try to use, like photographing the contents of a woman's desk drawer. ZPICs are private companies hired by the federal government to find and investigate allegations of fraud and abuse in healthcare programs.

“The ZPIC, despite the fact that it can be intimidating, does not have unfettered authority to do anything,” Perling said.


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